Abstract
Introduction: Insulin resistance (IR) is documented in patients with chronic hepatitis C(CHC), plays an important factor in disease progression and predicting poor response to treatment. In chronic liver disease, levels of insulin-like growth factor-1 (IGF-1) were correlated with IR. Aim: To evaluate IR and serum levels of IGF-1 in Egyptian patients with CHC after anti-viral therapy. Patients and Methods: Forty biopsy-proven, non-diabetic, CHC patients, who received combined IFN/ribavirin therapy, in addition to 10 healthy controls were studied. Serum levels of IGF-1, growth hormone (GH) were measured and HOMA-IR(homeostasis model assessment of IR), body mass index (BMI) were calculated. Baseline data, retrieved from patients’ files before initiation of therapy, together with response to antiviral therapy were analyzed with respect to the measured variables. Results: All patients possessed a significant higher HOMA-IR score (p = 0.02), GH levels (p < 0.001) and blood glucose levels (p < 0.001) than controls while significantly lower levels of IGF-1 were found in patients (p = 0.008)with no significant difference between responders and non-responders as regards the previously mentioned variables. HOMA-IR score was significantly correlated with GH levels, p = 0.003 and with IGF-1 levels in both responders and non responders. Low IGF-1 levels were associated with increase in fibrosis stages and were significantly correlated with insulin(r = –0.499, p = 0.001). Conclusion: CHC patients exhibit an increased HOMA-IR score reflecting the existence of IR irrespective of treatment response. Low IGF-1 levels were associated with advanced stages of fibrosis and thus could contribute to the progression of hepatic fibrosis in CHC.
Highlights
Insulin resistance (IR) is documented in patients with chronic hepatitis C (CHC), plays an important factor in disease progression and predicting poor response to treatment
All patients expressed a significant higher Homeostasis Model Assessment of Insulin resistance (HOMA-IR) score (p-value = 0.02), growth hormone (GH) levels (p-value < 0.001) and blood glucose levels (p-value < 0.001) than the controls; while mean levels of insulin-like growth factor-1 (IGF-1) were significantly lower in CHC patients; p-value = 0.008 (Table 1)
No dietary restriction or significant weight changes was reported during treatment or in the period afterwards in any of the recruited patients, only mild weight gain was reported by the majority of responders
Summary
Insulin resistance (IR) is documented in patients with chronic hepatitis C (CHC), plays an important factor in disease progression and predicting poor response to treatment. Levels of insulin-like growth factor-1 (IGF-1) were correlated with IR. Results: All patients possessed a significant higher HOMA-IR score (p = 0.02), GH levels (p < 0.001) and blood glucose levels (p < 0.001) than controls while significantly lower levels of IGF-1 were found in patients (p = 0.008) with no significant difference between responders and non-responders as regards the previously mentioned variables. Low IGF-1 levels were associated with increase in fibrosis stages and were significantly correlated with insulin (r = –0.499, p = 0.001). Hepatitis C virus (HCV) induced insulin resistance (IR) has been related to steatosis development, fibrosis progression and non-response to interferon (INF)/ribavirin therapy [1]. Increased liver iron accumulation and modification in the levels of adipocytokinemia can have an additional effect on insulin sensitivity in HCV infection [4]
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